Injecting heated chemotherapy into the pleural cavity, the region between the two thin layers lining the lungs, is a promising approach for patients who present with malignant pleural effusion (MPE) — the abnormal accumulation of fluid in the pleural space.
The open-label prospective study has shown that Platinol (cisplatin) at 43 degrees Celsius (or 109 degrees Farenheit) spread through the pleural space completely controlled the pleural effusion for three months in all patients, which included lung cancer and malignant pleural mesothelioma patients.
The findings were reported in the study, “Pharmacokinetic Evaluation Of Intrapleural Perfusion With Hyperthermic Chemotherapy Using Cisplatin In Patients With Malignant Pleural Effusion,” published in the journal Lung Cancer.
Malignant pleural effusion (MPE) is a condition characterized by the accumulation of extra fluid in the pleural space, which is located between the lungs and the chest wall. The condition results from cancer, especially lung and breast cancer.
Current treatment options for MPE include tube thoracostomy and sclerotherapy, but these methods are not completely effective — the success rate is about 64 percent — which accounts for the poor prognosis for this condition.
Previous studies have shown that hyperthermia (increased temperature) may increase the effectiveness of chemotherapy agents such as Platinol. This led research groups to test whether intrapleural perfusion with hyperthermic chemotherapy (IPHC) could work in patients with MPE.
The study enrolled 20 MPE patients (eight with lung cancer, seven with mesothelioma, and five with other conditions), ages 38 to 78, who were treated with IPHC. During pleural perfusion, the circuit was filled with a saline solution containing Platinol (80 mg/m2). Under video-assisted thoracoscopic surgery, the thoracic cavity was filled and perfused at a speed of approximately one liter per minute at a temperature of 43 degrees Celsius for one hour.
Results showed a complete control of pleural effusion for three months after IHPC in all cases, with low levels of Platinol-derived free platinum circulating in the blood, which accounted for controllable side effects. Common side effects included grade 1 kidney toxicity (six patients) and grade 1 vomiting (seven patients).
Together, these results suggest that this method may become a valuable option to treat MPE in patients.
“Our procedure, IPHC with [Platinol] at a dose of 80 mg/m2 for [one hour], was safe and effective,” the researchers wrote. “Due to no serious clinical complications and good control of MPE, post treatments after IPHS were performed within 37 days in all patients; 17 patients received chemotherapy and 3 patients received chemotherapy followed by extra-pleural pneumonectomy.”